This invention relates to devices that are capable of supporting or compressing an organ, such as the heart, and of exposing a given area of tissue to permit a surgical procedure to be performed in an area where minimal invasive procedures are desired. In particular, the invention relates to an endoscopic device that is capable of separating, exposing, stabilizing and supporting different tissues, organs and viscera so that appropriate areas of tissue are exposed.
Surgery on certain areas of an organ such as the heart is difficult because the organ is not easily accessible. In particular, as endoscopic surgery becomes more prevalent, the area accessible to surgery will become even more localized. The need for supporting the organ and presenting the appropriate surface for surgery will be even greater. For example, the heart is located beneath the chest wall and surrounded by a variety of other body organs and components, which makes it difficult to access. In addition, the heart continually moves (beats). In order to perform surgery on a particular area of the heart, the heart must be stopped completely or at least stopped in the area of surgery.
Typically, the chest wall is opened and the heart stopped completely for the time it takes the surgery to be performed (open heart surgery.) In some cases, the heart is stopped in particular areas using a device such as the Octopus Cardiac Tissue Stabilizer described in U.S. Pat. No. 5,927,284 to Medtronic. Surgery is then performed in the stopped area while the rest of the heart continues to beat (beating heart surgery). In an endoscopic version of heart surgery, the chest wall would not be opened but rather stab wounds would be made in the chest cavity at strategic points and the surgery performed while the heart remains behind the sternum.
One difficulty in this type of surgery is separating the heart sufficiently from other components within the chest cavity including the sternum and ribs. Another difficulty is stopping the heart in an area to perform the surgery. Although existing devices could be used to immobilize the heart for such surgery, any additional device used must be inserted into the relatively small chest cavity, taking up space.
It would be desirable therefore to have a device that separates the heart sufficiently from other tissues, organs and rib structures to present an area of the heart for surgery without obscuring that area.
Furthermore it would be desirable if the device could also support the heart, bracing it while causing little distress to the heart.
Additionally, it would be desirable if the device could be capable of immobilizing portions of the heart for surgery, thereby eliminating the need for an additional immobilization device, particularly in an endoscopic surgical procedure.
One aspect of the invention provides an endoscopic stabilization apparatus that includes first and second support elements positioned opposite each other, a plurality of linkages attached to the support elements and a cable attached to the linkages to allow a user to pull the cable to move the first support element in a direction away from the second support element. The apparatus may include a handle portion with an opening for the cable. The apparatus may include a securing mechanism operatively attached to an end of the cable. The first end of the linkages may be attached adjacent an edge of the first support element and the second end of each linkage may be attached adjacent an edge of the second support element. The midpoint of each linkage may also be attached to a connecting bar. The cable is attached in a fixed or a slidable manner at the midpoint of at least one of the linkages. The support elements may be pads arranged directly opposite each other. The support elements may be textured. The support elements may include suction elements. The support elements may return to a collapsed position when the cable is not in tension. The apparatus may be secured with a thumbscrew mechanism.
Another aspect of the invention provides a method of bracing an organ. An endoscopic support apparatus is provided. The apparatus is positioned in a collapsed configuration and inserted into a body cavity. Movement of the cable separates the support elements. At least one of the support elements is then braced against a component within the body cavity. The apparatus may then be secured in a desired configuration. The apparatus may include suction elements that are used to grasp the component within the body cavity.
Another aspect of the invention provides a method of stopping movement of a heart. An endoscopic support apparatus is provided. The apparatus is positioned in a collapsed configuration and inserted into a chest cavity. Movement of the cable separates the support elements. One of the support elements is then braced against an area of chest wall the other is braced against an area of the heart with sufficient pressure to stop movement of the heart. The apparatus may then be secured in a desired configuration. The apparatus may include suction elements that are used to grasp the chest wall and/or the heart.
Another aspect of the invention provides a support apparatus for separating an organ from a chest wall. The apparatus includes an elongated handle including an opening formed therein, a cable received in the handle opening, first and second support elements positioned opposite each other, a first linkage connected adjacent a first end of each of the first and second support elements, a midpoint of the first linkage connected to the cable, a second linkage connected adjacent a second end of each of the first and second support element and a midpoint of the second linkage connected to the cable. The cable is pulled to move the first and second support elements away from each other to separate the organ from the chest wall. The cable is attached in a fixed manner at the midpoint of the first linkage and in a slidable manner at the midpoint of the second linkage. The apparatus may include a securing mechanism attached to an end of the cable.
The foregoing and other features and advantages of the invention will become further apparent from the following detailed description of the presently preferred embodiments, read in conjunction with the accompanying drawings. The detailed description and drawings are merely illustrative of the invention rather than limiting, the scope of the invention being defined by the appended claims and equivalents thereof.